CRITICAL CARE BY EMERGENCY PHYSICIANS IN AMERICAN AND ENGLISH HOSPITALS

The object of this study was to compare emergency physician critical c are services in an American (A) and an English (E) Emergency Departmen t (ED). A prospective case comparison trial was used. The study was ca rried out at two university affiliated community hospitals, one in the U.S.A and one in England. Subjects were consecutive patients triaged as requiring critical care services and subsequently admitted to the h ospital ward (A, n = 17; E, n = 18) or the intensive/critical care uni t ([ICU] A, n = 14; E, n = 24). The study time period was randomly sel ected 8-h shifts occurring over a 4-week period. All patients were tre ated by standard guidelines for critical care services at the study ho spital emergency department. For all study patients mean length of sta y was significantly longer for the American (233 min, 95% CI 201, 264) than the English ED (24 min, 95% CI 23, 25). American emergency physi cians spent less total time providing physician services (19.2min, 95% CI 16.8, 21.6) vs. (23min, 95% CI 21.6, 24.4) than English emergency physicians. American emergency physicians spent less time with the pat ient than English emergency physicians: 12.4 min (95% CI 10.3, 14.5) v s. 17 min (95% CI 15.8, 18.2). American emergency physicians spent mor e time on the telephone 1.8 min (95% CI 1.4, 2.2) vs. 1.2 min (95% CI 1.1, 1.3), and in patient care discussions/order giving 1.8 min (95% C I 1.4, 2.2) vs. 1.1min (95% CI .8, 1.4). There was no significant diff erence in time charting (3.2min, 95% CI 2.8, 3.6 vs. 3.5 min, 95% CI 3 .2, 3.8). Results did not vary significantly whether analysed by subgr oups or the whole study group. American emergency physicians provided 81% of their service during the first hour. There were delays at the A merican hospital until the physician saw the patient: 4.9 min (95% CI 2.5, 7.3) for patients admitted to the ICU/CVU (Cardiovascular Unit), and 9.2 min (95% CI 4.6, 13.8) for patients admitted to the ward. At t he American hospital, ICU/CVU physicians provided additional physician services in the emergency department whether the patient was admitted to the ward (6.7min, 95% CI 5.5, 7.9) or the ICU/CVU (12.1 min, 95% C I 8.8, 15.9). For patients admitted to the ICU/CVU 47% of the length o f stay was spent waiting for a bed to become available after the decis ion to admit had been made. Emergency physicians at E provided critica l care services almost continuously during a short stay in the ED. Eme rgency physicians at A provided services intermittently with most serv ices during an initial period of stabilization. Further study is neces sary to identify what factors contribute to these different approaches to critical care in the ED.